Heparin,Dalt,Tinza, Enox, or Biosimilar?

[Linda Gross]

Hi

Trying to get sense of what centres across the country are using for hemodialysis circuit anticoagulation?  Saskatchewan is using dalt exclusively. What are you all using? Is anyone already talking about switching to a biosimilar?

Thanks in advance!

[Lori Wazny]

Hi Linda,

MB Renal Program still uses unfractionated heparin for in-centre HD.  We lock catheters with heparin 1,000 units/mL (not 4% citrate, not heparin 5.000 u/mL) so it’s not been cost-effective to switch to LMWH.

We do currently use dalteparin in Home HD patients using the NxStage machine and did previously use tinzaparin.

Are there biosimilar LMWHs coming out?  Which ones?

 

Thanks,

Lori Wazny, Pharm.D.

 

 

[Linda Gross]

Hi Lori. Thanks for the info. Yes, enoxaparin biosimilars were just approved and will hit the market shortly:

• Inclunox (Sandoz Canada)
• Noromby (Juno Pharmaceuticals Corp)
• Redesca (Shenzhen Techdow Pharmaceutical)

They could result in significant cost savings. I suspect there are not any centres using enoxaparin for hemo though.

 

[Elena Sze]

Hi Linda,

In Scarborough, the majority of our patients use dalteparin and the rest use unfractionated heparin for circuit anticoagulation. On the rare occasion, we use fondaparinux for patients with HIT.

Elena

[Darlene Llewellyn]

Hi Linda,

PEI uses dalteparin exclusively.

[Derrick Soong]

Hi everyone.

Windsor is essentially a dalteparin site for dialysis circuit patency. We had a couple of UFH but now we’re trying to flush the dialysis chamber with saline due to bleeding issues with UFH. But for VTE for those who cannot tolerate / contraindicated for warfarin (re: calciphylaxis) our local hematologist is using SC tinzaparin and monitoring anti-Xa levels accordingly.

I’m bumping this topic up … my managers are now exploring if there’s anything new with trying enoxaparin biosimilars for the HD circuit. I haven’t found very much on my quick search but was wondering if any other site is exploring this / have already made the switch to an enoxaparin biosimilar.  I’ll share my search once I get a chance to really look for what’s out there.

Any thoughts in the interim would be appreciated.

– Derrick

[Linda Gross]

Hi Derrick. Since my original post, there was no further interest in pursuing biosimilars in our unit. Now just to figure our what to do with all those patients on warfarin (re:citrate tube shortage), but that’s another topic.
/Linda

[Author]

Posts